J Neurol Surg Rep 2016; 77(01): e001-e007
DOI: 10.1055/s-0035-1564604
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic-Assisted Middle Fossa Craniotomy for Resection of Vestibular Schwannoma

Brian S. Chen
1  House Clinic, Los Angeles, California, United States
,
Daniel S. Roberts
1  House Clinic, Los Angeles, California, United States
,
Gregory P. Lekovic
1  House Clinic, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

28 January 2015

10 August 2015

Publication Date:
02 December 2015 (online)

Abstract

Background Rates of hearing preservation following surgery via middle fossa craniotomy in patients harboring tumors with unfavorable characteristics are significantly lower than for those patients with “favorable” tumors.

Objectives We will present two cases both with unfavorable conditions, which underwent endoscopic-assisted middle fossa craniotomy (MFC) resection of intracanalicular vestibular schwannomas with preserved postoperative hearing.

Methods Chart reviews were conducted on both patients. Their presentation, intraoperative details, and techniques, pre- and postoperative audiograms, and facial nerve outcomes are presented.

Results Patient A had 5.6 × 6.8 × 13.2 mm intracanalicular tumor with unserviceable hearing (pure tone audiometry [PTA], 41; speech determination score [SDS], 47%; class D) but was blind so hearing preservation was attempted. Postoperative hearing was preserved (PTA, 47; SDS, 60%; class B). Patient B had a 5 mm round intracanalicular tumor immediately adjacent to the vestibule and cochlea without any fundal fluid present. Preoperative audiogram showed serviceable hearing (PTA, 48; SDS, 88%; class B). Postoperatively, aidable hearing was preserved (PTA, 51; SDS, 76%; class C).

Conclusion Hearing preservation surgery via MFC can be enhanced with endoscopic-assisted dissection, especially in the lateral internal auditory canal. The superior optical view allows for preservation of cochlear nerve function and removal of residual tumor not otherwise seen on microscopy.